The overall objective of this K23 proposal is to support the early career development of Dr. Anne Fernandez, a clinical psychologist with specialized expertise in addiction and health psychology. This award will facilitate her program of research - evaluating and implementing screening, brief interventions, and referral to treatment (SBIRT) for alcohol use disorders in novel medical settings. Her career goal is to improve patient health, enhance hospital outcomes, and reduce healthcare costs through carefully timed alcohol-use interventions. In this career development award (CDA), she will facilitate these career goals by developing expertise in four training areas: (1) multi-disciplinar health services research, (2) SBIRT implementation practices, (3) qualitative data collection and analysis, and (4) quantitative methods in medical research. She will acquire this training through expert mentorship, formal coursework, and hands-on research. The research portion of this CDA is a randomized controlled trial that will pilot test SBIRT for risky alcohol use prior to elective surgery. This CDA builds on existing research indicating that moderate alcohol use (> 2 drinks/day) increases the risk of postoperative morbidity, while heavy alcohol use (> 4 drinks/day) increases the risk of postoperative mortality. These risk factors increase utilization f health care services, placing undue burden on patients, providers, and the healthcare system. To date, no randomized controlled trial has ever evaluated whether SBIRT can reduce alcohol use prior to elective surgery and improve postoperative health outcomes. This K23 will take the first steps in addressing this research gap. The three research aims are to: (1) assess the healthcare system to guide implementation of presurgical alcohol SBIRT, (2) to conduct an open trial of SBIRT in a presurgical clinic, and (3) to conduct a randomized pilot trial of alcohol SBIR prior to elective surgery. These research aims incorporate several novel components, including a mixed-method healthcare assessment and simultaneous evaluation of both efficacy and implementation outcomes. These steps will ensure the protocol addresses the needs of the larger healthcare system. Successful study completion will result in new information regarding the feasibility, acceptability, and efficacy of SBIRT for risky drinking prior to surgery. This program of research and training will allow the candidate to initiate a career conducting patient-oriented research that will ultimately reduce problematic alcohol use, improve patient health, bolster hospital outcomes, and reduce the cost of postoperative care.